<form method="post" action="{S_REPORT_ACTION}" id="report" style="font-size:11px">
	<div>
  		<fieldset class="fields2">
  		<dl class="left-box">
  			<dt><label for="reason_id">{L_REASON}:</label></dt>
  			<dd><select name="reason_id" id="reason_id" class="full"><!-- BEGIN reason --><option value="{reason.ID}"<!-- IF reason.S_SELECTED --> selected="selected"<!-- ENDIF -->>{reason.TEXT}</option><!-- END reason --></select></dd>
  		</dl>
  		<dl class="left-box">
  			<dt><label for="report_text">{L_SN_UP_MORE_INFO}:</label><br /><span>{L_SN_UP_CAN_LEAVE_BLANK}</span></dt>
  			<dd><textarea name="report_text" id="report_text" rows="10" cols="76" class="inputbox">{REPORT_TEXT}</textarea></dd>
  		</dl>
  		</fieldset>
	</div>
  		<fieldset class="submit-buttons" style="font-size:11px">
  			<input type="submit" name="submit" class="button1" value="{L_SUBMIT}" />&nbsp;
  			<input type="submit" name="cancel" class="button2" value="{L_CANCEL}" />
  			{S_FORM_TOKEN}
  		</fieldset>
</form>
